Idiopathic Pulmonary Fibrosis Outcomes Similar With Pneumonia or Acute Exacerbation

This article is part of Pulmonology Advisor‘s coverage of the American Thoracic Society International Conference, taking place in Dallas, Texas. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from ATS 2019.

DALLAS — Based on the 2016 International Working Group (IWG) diagnostic criteria for idiopathic pulmonary fibrosis (IPF), outcomes are relatively similar between patients with IPF with pneumonia and patients with an acute exacerbation of IPF. Mortality, however, appears to be somewhat lower in patients with IPF and pneumonia, according to study findings presented at the American Thoracic Society International Conference held May 17-22, in Dallas, Texas.

“Acute exacerbations of IPF are associated with high morbidity and high short-term mortality,” researchers wrote. “The 2016 IWG report proposed subcategorization of acute exacerbations as either ‘triggered’ or ‘idiopathic.’ [An] acute exacerbation can be triggered by pulmonary infection, so significance of pneumonia is unknown in the management of IPF according to the 2016 diagnostic criteria.”

Investigators retrospectively reviewed medical charts of patients with IPF who were admitted to a hospital in Japan for pneumonia. Patients were considered to have pneumonia if they had a fever or wet cough, increased white blood cell (WBC) count or C-reactive protein (CRP) level, and a newly developed focal infiltrate on imaging. The researchers excluded patients with acute exacerbations as detailed by the 2016 International Working Group criteria from the study. The A-DROP (Age, Dehydration, Respiratory failure, Orientation disturbance, and low blood Pressure) 6-point scale (0-5) proposed by the Japanese Respiratory Society was used to evaluate the severity of pneumonia.

During the 10-year study period, a total of 53 adults with IPF were hospitalized with pneumonia (mean age, 79±8). In this patient group, a total of 27 and 26 patients had community-acquired pneumonia and nursing- and healthcare-associated pneumonia, respectively. The values for WBC, CRP, and KL=6 were 13217±5162/μL, 14.9±10.9mg/dL, and 902±621U/mL, respectively. The A-DROP scores were as follows: 22 patients had a score of 1, 13 had a score of 2, 13 had a score of 3, 4 had a score of 4, and 1 had a score of 5. In 7 cases, noninvasive ventilation (n=3) or intubation (n=4) was required. In the overall cohort, patients had a mean hospital stay of 15 days (range, 3-145 days), 30-day mortality was 15.1%, and hospital mortality was 20.8%.

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An association was observed between the 30-day mortality rate of pneumonia and the A-DROP score (P <.0001). According to the researchers, “mortality rates were lower than those of acute exacerbations of IPF diagnosed based on the 2016 diagnostic criteria in our hospital.”

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Wada T. Clinical features and outcomes of idiopathic pulmonary fibrosis patients hospitalized for pneumonia. Presented at: the American Thoracic Society International Conference; May 20, 2019; Dallas, TX. Abstract A3703/P1063.